The exten­sive road trip by Soni­ta, a Gung­gari and Wak­ka Wak­ka woman, and Meli­na, a Gurind­ji woman, took place over almost a year as they vis­it­ed Queensland’s 15 mater­ni­ty Hos­pi­tal and Health Ser­vices (HHS). Dur­ing this time, the pair, which has over 10 years’ expe­ri­ence as mid­wives each, scoped each HHS’s mod­el of care to under­stand if there were part­ner­ships and co-design between the HHSs, the local Abo­rig­i­nal and Tor­res Strait Islander Com­mu­ni­ty Con­trolled Health Ser­vices and community.

The Strat­e­gy

The Grow­ing Dead­ly Fam­i­lies Abo­rig­i­nal and Tor­res Strait Islander Mater­ni­ty Ser­vices Strat­e­gy 2019 – 2025 sets out the vision that all Abo­rig­i­nal and Tor­res Strait Islander babies in Queens­land are born healthy, into strong resilient families.

This requires every woman in Queens­land giv­ing birth to an Abo­rig­i­nal and/​or Tor­res Strait Islander baby to have access to high qual­i­ty, clin­i­cal and cul­tur­al­ly capa­ble mater­ni­ty ser­vices. As the Strat­e­gy states, 42 per cent of Queens­land women miss out on ear­ly and fre­quent ante­na­tal care.

There’s a clear oppor­tu­ni­ty to improve access, and when engage­ment in care improves, par­tic­u­lar­ly mid­wifery con­ti­nu­ity of care, pos­i­tive out­comes will be achieved for women and fam­i­lies across the first 2,000 days of life.

The GDF Mid­wifery team under­took an analy­sis to check the HHS’s resources and capa­bil­i­ties with­in the clin­i­cal ser­vices capa­bil­i­ty frame­work, to deter­mine what mea­sures HHSs could take local­ly to sup­port local birth.

Par­tic­i­pants dis­cussed the many issues and bar­ri­ers of mater­ni­ty ser­vices that exist for Abo­rig­i­nal and Tor­res Strait Islander fam­i­lies. The fol­low­ing key areas for improve­ment emerged: cul­tur­al­ly appro­pri­ate and equi­table access to care, care close to home, con­ti­nu­ity and rela­tion­ship-based care to reduce retelling and repeat­ing health sto­ry, care to be pro­vid­ed by an Abo­rig­i­nal and Tor­res Strait Islander work­force, and the abil­i­ty to keep fam­i­lies together.

First-hand expe­ri­ence

Dur­ing the road trip, which at one time includ­ed eight flights in five days, Soni­ta and Meli­na were able to expe­ri­ence a small part of what it is like for women in remote loca­tions who have to leave their home at 36 to 38 weeks of preg­nan­cy and trav­el to anoth­er HHS to give birth.

“We expe­ri­enced a lit­tle of what the women have to go through – with the trav­el, for exam­ple,” says Melina.

“On top of hav­ing to be away from fam­i­ly and com­mu­ni­ty, women are often in a total­ly new envi­ron­ment, fac­ing new expe­ri­ences, trav­el­ling alone, and hav­ing to plan for the care of their oth­er chil­dren back home.

“Being away from home, fam­i­ly and com­mu­ni­ty not only has emo­tion­al impact, but there are finan­cial impacts.”

The expe­ri­ence was invalu­able for the mid­wives to be able to ful­ly under­stand the impact of leav­ing Coun­try at such a cru­cial time in women’s lives.

In addi­tion, they learnt that urban health ser­vices also face chal­lenges in achiev­ing and deliv­er­ing a cul­tur­al­ly safe and appro­pri­ate ser­vice for First Nations families.

Cul­ture, con­sul­ta­tion, and continuity

On their road trip, Soni­ta and Meli­na repeat­ed­ly heard that the three out­comes of the strat­e­gy were ful­ly supported:

• The need for mater­ni­ty ser­vices to have the full input of the com­mu­ni­ties involved.
• The need for con­ti­nu­ity of care from pre-preg­nan­cy through to birth and beyond.
• A focus on edu­cat­ing and employ­ing more Abo­rig­i­nal and Tor­res Strait Island peo­ples with­in services.

“It was clear that First Nations peo­ple want to have First Nations peo­ple giv­ing them care where pos­si­ble,” Soni­ta says, not­ing that women talked about a need for under­stand­ing of cul­tur­al knowl­edge and prac­tices to make them feel secure, safe, and con­nect­ed when they arrive in hospital.

Meli­na shared how a ter­tiary facil­i­ty was excelling in con­ti­nu­ity of care. This facil­i­ty oper­ates a con­ti­nu­ity of care mod­el from con­cep­tion to five years. The midwife/​maternity group prac­tice leans into child health which con­tin­ues with par­ent­ing class­es and activ­i­ties such as cook­ing and swim­ming lessons. They also have Wel­come Jar­jums to Coun­try cer­e­monies for their new babies, con­nect­ing them to Country.

While con­ti­nu­ity of mid­wifery care is vital for the mums and babies, Soni­ta points out that mid­wives them­selves are recog­nis­ing the improve­ment in their own work-life bal­ance and sense of sat­is­fac­tion when they can fol­low a mum and baby along the whole journey.

“Mid­wives who expe­ri­ence how reward­ing con­ti­nu­ity with a woman and her fam­i­ly can be fre­quent­ly state they do not want to go back to anoth­er way of pro­vid­ing mid­wifery care,” Soni­ta says.

The desire to return to birthing on Coun­try was a thread through­out their road trip, and Soni­ta and Meli­na were impressed with how com­mu­ni­ties adapt­ed to the cur­rent sit­u­a­tion, while also cam­paign­ing for change.

“One of my favourite exam­ples is Palm Island,” says Sonita. 

“This is a com­mu­ni­ty 60 kilo­me­tres out to sea from Townsville where his­tor­i­cal­ly First Nations peo­ple were sent as pun­ish­ment. I was so impressed by how resilient they are, their very strong advo­ca­cy for their com­mu­ni­ties on birthing issues. Palm Island community’s ulti­mate goal is to give birth on Country.”

Soni­ta has anoth­er exam­ple. A rur­al site in the north of Queens­land, one of many min­ing towns, is plan­ning to open birthing ser­vices local­ly. Once birthing opens, a num­ber of women will still trav­el from Coun­try to the hospital.

“To sup­port these women with con­nec­tion to their land, the hos­pi­tal – with con­sent – [has] had soil pro­vid­ed and trans­port­ed from dif­fer­ent Coun­try lands to the hos­pi­tal grounds to enable par­ents to place the soles of their babies’ feet into this soil. This con­nects them to their land.”

Next steps

The Grow­ing Dead­ly Fam­i­lies Strat­e­gy is intend­ed for pol­i­cy mak­ers and for those who deliv­er mater­ni­ty ser­vices to Abo­rig­i­nal and Tor­res Strait Islander fam­i­lies in Queens­land. It is expect­ed that all health pro­fes­sion­als who con­tribute to the mater­nal care of Abo­rig­i­nal and Tor­res Strait Islander moth­ers and babies will be able to draw on the Strat­e­gy to sup­port their prac­tice and mod­el of care.

Soni­ta and Meli­na are now off on the road again, under­tak­ing phase two of strat­e­gy imple­men­ta­tion, which involves sup­port­ing and advis­ing tar­get­ed health ser­vices to review their co-design process­es and explore the redesign of ser­vices, iden­ti­fy where there are gaps or where changes over the years mean new goals need to be con­sid­ered and met.

“We are con­scious that each com­mu­ni­ty is dif­fer­ent, and how impor­tant it is for us to yarn with the com­mu­ni­ties and all stake­hold­ers, because the com­mu­ni­ty know what they need and want, and will invest more into the mod­els of care when they are involved in estab­lish­ing them,” Meli­na says.

“This is true co-design. For First Nations mums and fam­i­lies to have a say in their care is some­thing that I whole­heart­ed­ly will always advo­cate for. I real­ly believe in this. We are grow­ing dead­ly families!”